Nerve-sparing RP can be performed safely in most men with localised prostate cancer (PCa). Clear contraindications are patients in whom there is a high risk of extracapsular disease, such as any cT2c or cT3 PCa, and any Gleason score (GS) > 7 on biopsy.
This externally validated nomogram predicting side-specific extracapsular extension can help guide decision making.
Multiparametric MRI might be helpful in selecting a nerve-sparing approach.
If any doubt remains regarding residual tumour, the surgeon should remove the neurovascular bundle (NVB). Alternatively, the use of intra-operative frozen-section analysis can help guide these decisions.
Resource: EAU guideline prostate cancer.
This algorithm is provided for educational, training and information purposes. It must not be used to support medical decision making, or to provide medical or diagnostic services. Read our full disclaimer.
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